{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T20:38:25Z","timestamp":1793651905415,"version":"4.5.1"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:p>\n            Objectives\u2003Internal carotid artery (ICA) injury remains a rare but potentially fatal complication of transsphenoidal pituitary or anterior skull base surgery. Preoperative imaging must be scrutinized to minimize risk. On axial computed tomography (CT), the protrusions of the ICAs into the sphenoid resemble a \u201cteddy bear.\u201d This article aims to describe the sign, its grading system (0\u20132) and quantify its presence.<\/jats:p><jats:p>\n            Design\u2003Retrospective review of preoperative CT imaging.<\/jats:p><jats:p>\n            Setting\u2003Tertiary referral center in the United Kingdom.<\/jats:p><jats:p>\n            Participants\u2003One hundred patients who underwent endoscopic transsphenoidal surgery for pituitary disease were enrolled.<\/jats:p><jats:p>\n            Main Outcome Measure\u2003The presence and grading of the \u201cteddy bear\u201d sign were assessed on preoperative CT imaging.<\/jats:p><jats:p>\n            Results\u2003A grade 2 (strongly positive) \u201cteddy bear\u201d sign was identified in 40% at the level of the superior pituitary fossa, 78% at the inferior pituitary fossa, and 59% at the clivus. A grade 1 (intermediate) sign was seen in 23.5, 7.5, and 10% of cases, respectively. In 5% of cases, the sign was grade 0 at all levels\u2014indicating poor intraoperative localization of the ICA.<\/jats:p><jats:p>\n            Conclusion\u2003The \u201cteddy bear\u201d sign is a useful preoperative tool for identification of anatomy predisposing patients to a higher risk of ICA injury. Those patients who have an absent or grade 0 \u201cteddy bear\u201d sign require extra care to ensure intraoperative localization of the ICAs which may include the use of neuronavigation or a Doppler probe. A grade 2 sign predicts good intraoperative localization of the ICA intraoperatively to inform the safe lateral limit of sellar bone resection.<\/jats:p>","DOI":"10.1055\/s-0037-1615749","type":"journal-article","created":{"date-parts":[[2017,12,26]],"date-time":"2017-12-26T23:32:44Z","timestamp":1514331164000},"page":"401-406","source":"Crossref","is-referenced-by-count":4,"title":["Radiological \u201cTeddy Bear\u201d Sign on CT Imaging to Aid Internal Carotid Artery Localization in Transsphenoidal Pituitary and Anterior Skull Base Surgery"],"prefix":"10.1055","volume":"79","author":[{"given":"W.","family":"Yeung","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Twigg","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Mirza","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2017,12,26]]},"container-title":["Journal of Neurological Surgery Part B: Skull Base"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0037-1615749.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T20:47:34Z","timestamp":1557175654000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0037-1615749"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,12,26]]},"references-count":0,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2018,7,12]]},"published-print":{"date-parts":[[2018,8]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0037-1615749","relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"value":"2193-6331","type":"print"},{"value":"2193-634X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,12,26]]}}}